MARYLAND MEDICAL ASSISTANCE PROVIDER HANDBOOK

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4 C h a p t e r 1 - H o w T o U s e T h i s H a n d b o o k This handbook provides a first reference source for information you need to know and actions you must take to bill Medical Assistance for medical services and supplies. Action tables appear throughout the material. These tables show you step numbers on the left and what actions to perform on the right. The Medical Assistance Program If you are not familiar with the Maryland Medical Assistance Program, Chapter 2 tells you why it was created and how it is organized. This chapter summarizes the history, purpose, organization and administration of the Maryland Medical Assistance Program. Medical Assistance Recipient Eligibility Chapter 3 describes various programs in which recipients may participate and tells you how to read Medical Assistance cards that the recipient may show you. Steps to Take Before Providing Services Chapter 4 tells you what to do before you provide services to the Medical Assistance recipient. It tells you how to determine if Medical Assistance will pay for the service you intend to provide. Preparing Claims and Forms Chapter 5 tells you how to complete a claim for payment. The introduction to the chapter briefly explains how the payment system works. How You Will Get Paid Chapter 6 explains how Medical Assistance determines specific payment amounts once a claim is approved for payment. Other topics that affect payment, such as other insurance coverage, are discussed. How the Program Processes and Responds to Your Claim Chapter 7 tells you how the Maryland Medical Assistance Program processes your claim and how long it normally takes and also tells you what to do when the State responds to your claim. Your claims must be complete, accurate and for a covered recipient and services before Medical Assistance can consider payment. Trouble-Shooting Guide Chapter 8 contains a trouble-shooting guide, which provides several helpful hints and tips. How to Order Forms Chapter 9 tells you how to order forms necessary for payment. June 30, 1999 Chapter 1 - How to Use This Handbook Page 4

5 Provider Participation Chapter 10 explains your obligations and rights as a Medical Assistance provider. The topics covered include civil rights, confidentiality, provider eligibility, enrollment changes, record keeping requirements and fraud/abuse review. Important Phone Numbers and Addresses Chapter 11 provides contact points for several types of information including resubmittal of claims and Provider Relations. Appendices Appendix A describes various supplements available, including specific billing instructions and a third party carrier listing. Copies of several forms are reproduced in Appendix B. The Rare and Expensive Case Management Handbook is reproduced in Appendix C. Glossary The glossary is a list of terms used either in this handbook or by the Program along with their definitions. The terms are defined because the Maryland Medical Assistance Program may have special meanings for them. Revised July 15, 1999 Chapter 1 - How to Use This Handbook Page 5

6 C h a p t e r 2 - T h e M e d i c a l A s s i s t a n c e P r o g r a m History of the Maryland Medical Assistance Program The Medical Assistance Program (also referred to as Medicaid, the Program or Title XIX) is a federally and State funded program which entitles poor and medically needy persons to medical care and related services. The Program provides access to a broad range of health care services for eligible Maryland residents. The Medical Assistance Program provides eligible people with services to promote self-care. Congress created the Medical Assistance Program in 1965 through Title XIX of the federal Social Security Act. Medical Assistance derives its legal authority from Title XIX, Section 1902 (a) of the Social Security Act and from Title 15 of the Health-General Article, Article 43, Section 42, of the Annotated Code of Maryland. State regulations pertaining to Medical Assistance are found in Title 10, Subtitle 09, of the Code of Maryland Regulations (COMAR). The Maryland Medical Assistance Program began on July 1, 1966, during the administration of Governor J. Millard Tawes. It is administered by the Maryland Department of Health and Mental Hygiene (DHMH) Medical Care Programs, which consists of three administrations: Medical Care Finance and Compliance Administration (MCFCA), Medical Care Policy Administration (MCPA) and Medical Care Operations Administration (MCOA). In order to receive federal funds, Maryland must comply with federal regulations. The federal regulations for Medicaid are located in Title 42 of the Code of Federal Regulations. The regulations provide two types of Medical Assistance services for the State: mandatory and optional. To receive federal financial participation, states are required to provide Medicaid coverage for most individuals receiving welfare, as well as for related groups not receiving cash payments. In addition, states must offer certain health care services such as inpatient and outpatient hospital services, physician services and nursing facility services. States may also receive federal funding if they elect to provide optional services such as clinic services, pharmacy services and dental services. Program Administration The Medical Assistance Program, has different levels of governmental involvement. Federal State Local The U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) administers the Medical Assistance Program at the federal level. The Maryland Department of Health and Mental Hygiene (DHMH) administers Medical Assistance at the State level. The Department of Human Resources and its Local Departments of Social Services and Local Health Departments determine Medical Assistance eligibility. Revised October 12, 2001 Chapter 2 - The Medical Assistance Program Page 6

7 C h a p t e r 3 - M e d i c a l A s s i s t a n c e R e c i p i e n t E l i g i b i l i ty What Determines Eligibility A person can qualify for Medical Assistance in several ways: 1. A person is eligible for health care coverage under Medical Assistance if he or she receives cash assistance under Temporary Assistance to Needy Families (TANF) or Supplemental Security Income (SSI). 2. A person may also qualify for federal Medical Assistance under one of the following categories: aged (age 65 or over), blind, disabled, caretaker relative of dependent child(ren) under 21 years old, children under age 21, pregnant women. If a person falls into one of these categories, the remaining qualifications for eligibility are based primarily on what the person has in the way of available income and assets. If both are within certain established levels, the person is financially eligible. Income for the above categories include both earned income and unearned income. Earned income includes wages, salaries, commissions and profit from self-employment. Unearned income includes Social Security benefits, dividend income, Veteran=s benefits and retirement benefits. Assets mean accumulated personal wealth over which a person has the authority or power to liquidate his/her interest. Assets include cash savings, savings accounts, checking accounts, stocks, bonds, etc.. A person who is ineligible, because he/she has income which exceeds the income eligibility level, may be able to become eligible for a limited period of time by reducing his/her excess income with incurred medical expenses. This is called the Αspenddown process. If a person applies, and is determined ineligible due to excess income, he/she will be provided information on how eligibility may be established through spenddown. The medical expenses used to establish eligibility under spenddown remain the person=s liability after eligibility for Medical Assistance is established. If a person is receiving certain services, such as nursing facility services, eligibility is determined on a different basis. The cost of the person=s care is taken into consideration, and the person is required to pay a fixed monthly amount towards his/her care. This amount is deducted from the Program=s payment. 3. The Maryland Children=s Health Program (MCHP) provides coverage to pregnant women and children with family incomes which do not exceed 200% of the federal poverty level. Only pregnant and postpartum women, and children, under age 19, are eligible. As of July 1, 2001, MCHP has expanded its program. This new expanded program is called MCHP Premium. The MCHP Premium will provide coverage to children under 19 with family incomes that exceed 200% but at or below 300% of the federal poverty level. Participation in the MCHP Premium will require a family contribution based on income. Pregnant women on MCHP receive all benefits covered under the regular Medical Assistance Program except for abortion. Children on MCHP receive all benefits. A woman delivering on MCHP receives family planning benefits through the Family Planning Program for 5 years following the birth of her child. Revised October12, 2001 Chapter 3 - Medical Assistance Recipient Eligibility Page 7

8 How Eligibility Is Established Recipient eligibility for Medical Assistance is determined by the Local Departments of Social Services (LDSS) and Local Health Departments (LHDs) in accordance with criteria established by the Medical Assistance Program. (See Chapter 11 for a list of the locations of the LDSS and LHDs). In general, a person wishing to apply for Medical Assistance may do so at his/her local department of social services in his/her county of residence, or Baltimore City if he/she lives in Baltimore City. In addition, many of the acute care hospitals in Maryland also have eligibility workers who can take Medical Assistance applications. A written and signed application is required of each applicant for Medical Assistance. An applicant may be required, as part of the application process, to verify the information given on an application form. Pregnant women of any age and children up to the age of 19 can apply for the Maryland Children=s Health Program at Local Health Departments, or Departments of Social Services. They may be eligible if the family income is at or below 200% of federal poverty level. Providers, parents and pregnant women may contact their Local Health Department or DHMH at if they have further questions or need more information pertaining to the program. TDD for Disabled-Maryland Relay Service A person may also apply for the Maryland Pharmacy Assistance Program (MPAP). To receive a MPAP card, the recipient MUST complete a Maryland Pharmacy Assistance Program Application form. The recipient must follow the instructions on the form and mail it to the address listed in Chapter 11. The recipient must provide proof of all sources of income and assets. If the recipient has no income or assets, he/she MUST provide a letter of support from his/her caregiver. Persons who have Medicare as well as limited income and resources may qualify for participation as a Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or Qualifying Individual (QI). These persons are eligible for assistance with their Medicare premium payments. Qualified Medicare Beneficiaries (QMB=s) also qualify for assistance with their Medicare deductibles and co-insurance. Individuals should contact the Local Department of Social Services in their county of residence (or Baltimore City) to find out if they are eligible for any of these programs or for regular Medical Assistance. It is the provider=s responsibility to verify a recipient=s current eligibility each time service is provided. A patient=s Medical Assistance eligibility should be verified on each date of service prior to rendering service by calling the Eligibility Verification System (EVS) at the number listed in Chapter 11. June 30, 1999 Chapter 3 - Medical Assistance Recipient Eligibility Page 8

9 Eligibility of Newborns With few exceptions, babies born to women with Medical Assistance coverage are automatically eligible for Medical Assistance for the first year of life. Hospitals are responsible for filling out a form called the 1184 and mailing it to the Medical Assistance Program so that a card can be issued. This means that newborns will receive a Medical Assistance card within two weeks of birth if the hospital has filled out the form promptly. The newborn=s Medical Assistance number will be on EVS. A child born to a mother enrolled in a MCO on the day of delivery will automatically be enrolled in that MCO at birth. Providers must bill for services to the newborn on the newborn=s card, not his/her mother=s card. If you have any questions or concerns about this process, please call the Outreach and Women=s Services Division as listed in Chapter 11. Spenddown Process When a person applies for Medical Assistance, the Program determines if the amount of countable income the applicant receives is within the Medical Assistance income eligibility standard. If the application is for multiple family members, their income may also be counted. If the applicant=s income exceeds the Medical Assistance income eligibility standard, the Program determines the applicant ineligible for Medical Assistance because of excess income and tells the applicant that he/she may become eligible through the Αspenddown process. When the Program determines how much income the applicant receives, it also calculates the income the applicant will receive for a six-month period. The Program then compares that amount against the Medical Assistance eligibility standard for the same six-month period. The difference between the amount of income the applicant receives and the amount that is allowed is called excess income. If the applicant has excess income, the Program will hold his/her case open to allow the applicant to incur medical expenses and to use those expenses to reduce the amount of excess income to the Medical Assistance income eligibility standard. If the applicant succeeds in reducing the amount of excess income to the Medical Assistance income eligibility standard, at any time during the six-month period, the Program will make the applicant eligible for the time remaining in the six-month period. At the end of this eligibility period, the applicant must reapply for Medical Assistance and the whole process begins anew. Only medical expenses can be used in the spenddown process. Medical expenses include hospital and doctor=s bills, prescription drugs, medical equipment, etc. Any medical expenses used to make the applicant eligible will remain his/her responsibility. Any expenses that are paid by someone else, such as an insurance company or Medicare, cannot be used in spenddown. A medical expense can only be used once for spenddown. If you have any questions about the spenddown process, contact an eligibility policy specialist at the phone numbers listed in Chapter 11. June 30, 1999 Chapter 3 - Medical Assistance Recipient Eligibility Page 9

10 Recipient Participation A person who has been determined eligible for Medical Assistance may participate in one of several programs. The next several pages describe such programs. For those programs which issue a unique identification card, the program is described and followed by a picture of the Medical Assistance identification card associated with that program. Several programs do not issue unique identification cards; these are also described in the following pages. Each Medical Assistance recipient, when initially enrolled, is issued a red and white Medical Care Program identification card. Recipients enrolled in the Managed Care Program are also issued a distinctive Managed Care Organization (MCO) card by that particular MCO. Following is a list of cards issued by the Program: Card Color Red and White Blue and White Brown and White Yellow and White Gray and White Purple and White Issued For Recipients With For both recipients enrolled in HealthChoice and for fee for service identification Hospice Care Maryland AIDS Drug Assistance Program (MADAP) Pharmacy Assistance Program (MPAP) Qualified Medicare Beneficiary (QMB) Family Planning Program June 30, 1999 Chapter 3 - Medical Assistance Recipient Eligibility Page 10

11 HealthChoice In June, 1997, Maryland Medical Assistance began ΑHealthChoice the Medicaid Managed Care Waiver Program. Medical Assistance capitates Managed Care Organizations (MCO=s), to provide care for most Medical Assistance recipients. This care includes provision and coordination of health care, and fiscal management of Medical Assistance benefits for these recipients. Some Medicaid recipients are excluded from HealthChoice and will continue with fee-for-service Medicaid. Those recipients are: Χ those recipients who are dually eligible for Medicare and Medicaid; Χ those recipients who are institutionalized in nursing homes, Chronic Hospitals, Institutions for Mental Diseases (IMDs) or Intermediate Care Facilities for the Mentally Retarded (ICF-MR); Χ individuals who are eligible for Medical Assistance for a short period of time; Χ those recipients in the Model Waiver program for children who are medically fragile; and Χ persons receiving family planning services through the Family Planning Waiver. Recipients who are part of the MCO program will receive information regarding changing their MCO, one time per year, on the anniversary date of their MCO linkage. Information regarding recipient eligibility or MCO linkages should be obtained using the Eligibility Verification System (EVS) at or In order to use this system, you must have an active Medical Assistance provider number. If you need assistance with understanding EVS, please contact the Medical Care Liaison Unit at Providers wishing to participate with the MCO program, must contact the MCO=s directly using the list on the next page. If you are unable to obtain a contract with any of the MCO=s, please contact a member of our Policy Administration at However, please keep in mind that the most efficient way to gain HealthChoice provider status is to sign-up with the MCO. Recipient Protection DHMH understands the importance of protecting the recipient=s choice of MCOs under this program. Providers who want to provide Medicaid services may notify their Medicaid patients of the MCOs which they have joined or intend to join. However, providers must disclose the names of all MCOs in which they expect to participate under HealthChoice and may not steer a recipient to a particular MCO by furnishing opinions or unbalanced information about networks. In order to communicate HealthChoice information, it is imperative that DHMH has current addresses of recipients. As providers, you are in a unique position to inform recipients of the importance to pass on any new address information to DHMH. When possible, please inform recipients that they must give their correct address to their Department of Social Services. If recipients receive SSI, they will need to change their address with the Social Security office. June 30, 1999 Chapter 3 - Medical Assistance Recipient Eligibility Page 11

12 Managed Care Organizations Amerigroup Mr. Paul Bechtold Baltimore City, A.A. 857 Elkridge Landing Road Director, Provider Relations Balto.,Montgomery, Linthicum, MD (410) and Prince George=s (410) Fax (410) Counties Exec: Don Gilmore, COO Chesapeake Family First Ms. Barbara Spence Statewide except (United Health Care of the Mid-Atlantic, Inc) (410) Garrett 6300 Security Blvd. Fax (410) Baltimore, MD Exec: Robert Sleshner Helix Family Choice, Inc. Lyse Wood Baltimore City, A.A Sandpiper Circle, Suite O Provider Relations Baltimore, Carroll, Lutherville, MD (410) Harford, Howard (410) Fax: (410) Counties. Exec: Peter Mongroo, President JAI Medical Systems, Inc. David Burke Baltimore City, 5010 York Rd. Director, Provider Relations Baltimore County. Baltimore, MD (410) Exec: Hollis Seunarine, M.D. Fax: (410) Maryland Physicians Care MCO Mr. Tom Sommer Statewide except 7104 Ambassador Rd. Suite 100 (410) Caroline, Dorchester, Baltimore, MD Fax: (410) Kent,Prince George s, (410) Queen Anne s, CEO: Raymond Grahe Somerset, Talbot, Wicomico and WorcesterCountie Priority Partners MCO Ms. Denise Quandt Statewide except Baymeadow Industrial Park VP of Provider Relations Garrett County 6701 Curtis Court (410) Glen Burnie, MD Fax: (410) (410) COO: Cynthia Demarest Revised October 12, 2001 Chapter 3 - Medical Asssitance Recipient Eligibility Page 12

13 Covered Services The MCO=s are responsible for providing all Medicaid covered services excluding the following, which are paid fee-for-service by Medicaid: Χ Χ Χ Χ Χ Χ Χ Χ Χ Χ Χ Abortion Services - MCO=s are responsible for related services performed as part of a medical evaluation prior to the actual abortion. Aids Drug Therapies - Limited to Protease Inhibitors, Non-nucleoside Reverse Transcriptase Inhibitors and viral load testing. Healthy Start Case Management Services IEP/IFSP - Individual Education Plan (IP) or Individual Family Services Plan (IFSP). Medically necessary services that are documented on the IEP or IFSP when delivered in schools or by Children s Medical Services community based providers. Medical Day Care Services Nursing Home/Long Term Care Facility Services - After the first 30 consecutive days of care. Personal Care Services Rare & Expensive Case Management Services (REM) - Recipients are eligible based on one of the diagnoses listed in COMAR (See REM information in Appendix C) Recipients receive all State Plan Medicaid services on a fee-for-service basis. Specialty Mental Health Services - Including inpatient admissions to Institutions for Mental Disease (IMD). These services are payable through the Administrative Services Organization, Maryland Health Partners. For information, call Stop Loss Case Management (SLM) - A recipient participating in a MCO which does not self insure becomes eligible for the Stop Loss Case Management Program when his or her paid inpatient hospital services exceed $61, At that point, the Program pays 90% of inpatient charges, while the MCO pays the remainder. Once SLM eligibility is in effect, the recipient is also eligible to receive case management and additional services available through the REM Program. Transportation Services - MCO=s may, however, be responsible for transportation services which are not covered by fee-for-service Medicaid. Recipients are linked by their MCO to a primary care physician or clinic, and must obtain all services except the above through their MCO. The recipient=s primary care physician or clinic will give referrals for specialty care. However, the following services must be reimbursed by the MCO without a referral: Revised July 15, 1999 Chapter 3 - Medical Assistance Recipient Eligibility Page 13

14 Self-referral services are defined in the HealthChoice regulations as Αhealth care services for which under specified circumstances the MCO is required to pay without any requirement of referral or authorization by the primary care provider (PCP) or MCO when the enrollee accesses the services through a provider other than the enrollee=s PCP. Self-referral services include: Χ Child With Pre-Existing Medical Condition - Medical Services Χ Child In State-Supervised Care - Initial Medical Exam Χ Emergency Services Χ Family Planning Services Χ HIV/AIDS Annual Diagnostic and Evaluation Service Visit Χ Newborn=s Initial Medical Examination In A Hospital Χ Pregnancy-Related Services Initiated Prior To MCO Enrollment Χ Renal Dialysis Services Provided In A Medicare Certified Facility Χ School-Based Health Center Services Χ Substance Abuse Assessment For additional information regarding the above self-referral services contact the Medical Care Policy Administration at Billing Providers should also contact the MCO=s for billing regulations and instructions related to self-referral services. Claims for excluded services and fee-for-service should be submitted to Maryland Medical Assistance, Medical Care Operations Administration, P.O. Box 1935, Baltimore, MD June 30, 1999 Chapter 3 - Medical Assistance Recipient Eligibility Page 14

15 Mental Health Services As part of the 1115 waiver process, specialty mental health services, those services provided by a mental health professional or a mental health service agency which are not performed as part of a primary practitioner=s office visit, were carved out into a separate managed fee-for-service system. This system, the Specialty Mental Health System (SMHS), is administered by the Mental Hygiene Administration (MHA), local Core Service Agencies (CSA=s), and an administrative services organization, which is currently Maryland Health Partners (MHP). MHP authorizes services and pays claims for the SMHS. Any claims for non-emergency specialty mental health services for both HealthChoice and non -HealthChoice recipients must be authorized and paid by MHP. For some organizations and practitioners, all claims must be paid by MHP. These include special acute psychiatric facilities, both inpatient and outpatient services, special chronic psychiatric facilities, both inpatient and outpatient services, residential treatment center, psychologists, certified nurse psychiatric specialists, community mental health centers, psychiatric rehabilitation programs, mental health case management agencies, and mental health mobile treatment agencies. For other organizations and practitioners, only specific services rendered to recipients with defined diagnoses will be paid by MHP. These providers include acute hospital and acute rehab inpatient and outpatient psychiatric services, chronic and chronic rehab inpatient and outpatient services, special acute and special chronic inpatient and outpatient psychiatric services, psychiatrists, behavioral pediatricians, social workers, licensed professional counselors, local health departments, and FQHC s and MQHC s. Practitioners who want to participate individually or as groups as specialty mental health providers must be appropriately licensed and must be able to provide services under their licensure. Organizations that want to participate as specialty mental health providers must be licensed or approved by the Office of Licensing and Certification. All providers, individuals, groups, or organizations, must be enrolled by both the Maryland Medical Assistance Program and by Maryland Health Partners. Further information about becoming a provider in the SMHS may be obtained from MHP s provider line at June 30, 1999 Chapter 3 - Medical Assistance Recipient Eligibility Page 15

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19 Pharmacy Assistance Program (MPAP) The Maryland Pharmacy Assistance Program is 100% State funded and provides pharmacy services to persons who are not eligible for participation in the Medical Assistance Program, but who meet the eligibility requirements of the Pharmacy Assistance Program. Recipients are liable for a co-payment for each original prescription and refill. Eligibility for the Maryland Pharmacy Assistance Program is based on the size of the recipient=s household and the financial resources (total gross income and current assets) available to the family unit. The Program increases the maximum gross allowable income standards annually at the time Social Security benefits are increased, by the larger of either any Social Security cost-of-living percentage increase, not to exceed 8%, or the dollar amount which the Medical Assistance income standards are increased by the State. MPAP is a program to help Maryland residents pay for certain maintenance drugs used to treat long term illnesses, anti-infective drugs such as AZT, insulin syringes and needles. Under the Program, the recipient pays $5 for each prescription and each of two refills and the State pays the rest. For further information regarding the Maryland Pharmacy Assistance Program, call the number listed in Chapter 11. June 30, 1999 Chapter 3 - Medical Assistance Recipient Eligibility Page 19

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21 Qualified Medicare Beneficiary For recipients who qualify, participation in the Qualified Medicare Beneficiary (QMB) Program allows the Medical Assistance Program to pay the recipient=s Medicare medical insurance premium. In addition, the Program will also pay the Medicare deductibles and co-insurance. Individuals who would be Qualified Medicare Beneficiaries except that their income is slightly above the national poverty level may qualify for help in paying their Part B (Medical insurance) premium under the Speficied Low-Income Medicare Beneficiary (SLMB) Program. This program does not cover Medicare co-pays and deductibles, and no identification card is issued to SLMB recipients. Beginning in January 1998, the State pays either the full Medicare Part B premium or a portion of the Medicare Part B premium for Qualifying Individuals (QIs). The partial premium payment is refunded directly to the individual once a year. QIs are individuals whose income exceeds the levels for QMBs and SLMBs. June 30, 1999 Chapter 3 - Medical Assistance Recipient Eligibility Page 21

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24 In addition to the programs described above, recipients of Medical Assistance often are involved in the following programs for which the Medical Assistance Program does not issue unique identification cards. Medicare Who Must Enroll Medical Assistance recipients or applicants who are eligible for Medicare must enroll in Medicare in order to participate in the Medical Assistance Program. Enrollment in Parts A & B Medicare is a federal health care insurance program for people who are 65 years and older and some people under 65 who are blind or disabled. Medicare has two parts. Part A covers hospitalization, dialysis services and post-hospital care in a skilled nursing facility. Part B covers other Medical services, including physicians= services, medical supplies, home health services and physical therapy. The Medical Assistance Program pays the recipient=s deductible and co-insurance for both Part A and Part B. The Program will also pay the monthly Part A premium for people 65 and older with low income and limited resources who do not qualify for premium-free Part A. It also pays the monthly insurance premium for Part B. If a Medical Assistance recipient is enrolled in Medicare Part B, the Medicare identification number is shown on the recipient=s Medical Assistance card if the Program is aware of the enrollment. Medical Assistance is Payer of Last Resort The Medical Assistance Program is by law the payer of last resort. The Medicare carrier will process the invoice, pay the Medicare portion and then send the bill to Medical Assistance for payment of deductibles and co-insurance when the carrier has a crossover agreement with the State. The provider must check the appropriate block on the Medicare form which indicates acceptance of assignment in order for the Medical Assistance Program to pay the deductible and co-insurance. In addition, the recipient=s Medical Assistance number must be entered in the appropriate space on the Medicare form. Medical Assistance sends a file of eligible recipients to some Medicare carriers, and that file is used to select the claims they pass to Medical Assistance. Medicare Information Resources For further information regarding Medicare, contact one of the carriers listed in Chapter 11. Maryland Healthy Kids Program/EPSDT The Maryland Healthy Kids Program, known on the federal level as the Early and Periodic Screening, Diagnosis and Treatment Program, offers comprehensive health care services which are designed to detect physical and mental problems and provide necessary follow-up care to Medical Assistance Recipients under 21 years of age. Children receive a more comprehensive service package than adults with Medical Assistance coverage. Revised October 12, 2001 Chapter 3 - Medical Assistance Recipient Eligibility Page 24

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